The Role Of Loss Adjusters

Insurance Loss Adjusters, Insurance Claims and Litigation

Most of us think an insurance company is our ally when we make a claim - that the insurance company is merely supplying the service that we paid for. And as some advertisements say, we remain in its good hands. Yet, because theft, fire and storm insurance providers are highly vulnerable to fraud, they carefully investigate claims, particularly large claims where the persona making the claim seems nervous or makes repeated inquiries or uses unusual tactics to expedite their claim.

An insurance loss adjuster may talk to the individual making a claim, examine damaged building structures and content, and then research the value of damaged property and possessions. However, no matter how friendly a loss adjuster is, remember his job is to save cash for the insurance company that they work for. At the same time, the insurance company will contact law enforcement or fire department professionals.

Considering that declarations to these authorities can form the basis for rejecting a claim, comply without making unnecessary remarks.

Anything a person that is making a claim says can and will be utilized against them later on. If the insurer retains an attorney to take your statement, presume that you are the target of the examination and work with a lawyer to represent you. In truth, the insurance provider might have currently chosen to reject your claim.

When insurers have concluded their investigations, they have 3 options:

a) Pay the claim completelyb) Pay part of the claim, prohibiting some of the value of the claimc) Reject the claim

Claim rejections typically cite different factors and on occasion, they may identify insurance fraud by the person who made the complaint as one factor.

By the time a claim has actually been denied, the insurance provider may have already engaged insurance loss adjusters Manchester firms utilize to completely examine the claim and taken the sworn statements of pertinent witnesses, consisting of the “plaintiff” and police or fire authorities.

As soon as a claim is denied, it is up to you as the “plaintiff” to file a well documented claim complete with detailed evidence in support of it. If successful with your claim, your award will be restricted to the insured amount of your claim unless you can show that the insurance coverage company had no sensible reason for rejecting the claim.

If you can establish that the insurer acted in an unreasonable manner, you might be entitled to additional damages. These claims are difficult to prove and are frequently dismissed before any legal action is initiated.

However, if the insured party and the insurance company cannot agree a claim, then legal proceedings may follow. As part of these proceedings, the insurance company's legal team will normally take the opportunity take a sworn statement or “deposition” from you. There is a high probability that any deposition that is recorded more than 12 months after your preliminary sworn declaration will contain some disparities for the opposing attorney to utilize in opposition to your case if it goes to a trial.

During this litigation process something called the “discovery procedure” may be your very first opportunity to find out the insurer's basis for denying your claim. While your lawyer will be able to cross examine the different witnesses who provided sworn declarations to the insurer during the investigation, unlike the insurer, this will be the only opportunity he needs to question these witnesses prior to trial. Meanwhile, an insurance provider that has actually defeated a bad faith claim may successfully oppose any effort by your lawyer to depose its staff members. Many insurance businesses will choose not to settle lawsuits in which they have declared fraud.

While insurance coverage fraud is a criminal activity, most rejected claims do not lead to prosecutions. Nevertheless, insurance companies have access to a wide range of civil litigation remedies at its disposal. A statute in one US state entitles an insurance provider that has been defrauded to its lawyers' fees and other costs of the investigation and defense.

Given that you will not know if any insurance company investigation is in reality preparatory activity for an impending lawsuit, follow these guidelines:

- When responding to inquiries from insurance company representatives, make sure that you keep your responses brief and say as little as possible. Many plaintiffs are so friendly with investigators and attorneys that they forget that these individuals might be collecting hard evidence to prove that fraud has taken place.

- Make sure that whenever you communicate any facts relating to your claim that your communications are consistent with private investigators, loss adjusters, police, fire officials and lawyers. Some claimants feel that little, seemingly inconsequential lies, which streamline their claims, will benefit their cause. While immaterial misrepresentations will not revoke a claim, even the most insignificant lie can lead to the dismissal of a bad faith claim and make you look deceitful if the case goes to trial.

- If the insurance company employs a legal representative, then so should you. No matter what the insurance provider says, once the insurance company has actually instructed a lawyer, do the exactly the same yourself.

In order to protect your best interests, be cautious and seek legal guidance early in any claims process that maybe the subject of serious litigation later.